Eli Lilly’s Cyramza (ingredient: ramucirumab), treating metastatic gastric cancer, will receive insurance coverage, the government said. The benefit comes three years after gaining local approval in 2015.
The Ministry of Health and Welfare said its health insurance policy review committee revised the list of reimbursed medicines and reimbursement caps on Tuesday.
Cyramza was released in 2016 without insurance benefit, after obtaining sales license in April 2015.
In 2016, Eli Lilly Korea applied for insurance coverage for Cyramza. However, the Health Insurance Review and Assessment Service’s drug reimbursement evaluation committee rejected the request, citing the treatment’s uncertain cost-effectiveness, compared to alternative drugs.
This year, insurance review panel finally decided to give insurance benefit to Cyramza, after the second assessment by the drug reimbursement evaluation committee in January and drug pricing negotiations with the National Health Insurance Service (NHIS) from February to April.
Cyramza won the nod as “a monotherapy or combination therapy with paclitaxel for advanced or metastatic gastric cancer or gastroesophageal adenocarcinoma, during or after chemotherapies including fluoropyrimidine or platinum.”
The reimbursement will be available only in the following cases; when the first-line treatment of fluoropyrimidine + platinum (cisplatin, oxaliplatin) ± anthracycline (doxorubicin, epirubicin) failed; and when ECOG (Eastern Cooperative Oncology Group) Performance Status was either 0 or 1. In the latter case, the reimbursement is limited to the combo therapy of Cyramza and paclitaxel.
The price has been set at 331,500 won ($307.6) for Cyramza 100mg, and 1,525,000 won for 500mg, with the risk-sharing agreement (RSA) applied.
RSA refers to an agreement between a pharmaceutical firm and the NHIS to share the responsibility for uncertainties regarding the new drug’s efficacy and impact on the NHIS’ financial status.
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